Your OR’s Safety Checklist

Use these proven safety measures to keep caregivers and patients safe.

Being aware of the high-risk tasks — the kind that people typically end up sustaining injuries from — is the first step in developing a culture of safety for your staff and your patients.

You never want to be in a situation where you or your staff are unprepared to handle the myriad of perilous situations that may arise.

Here are some proven steps that hospitals and ASCs can take to help prevent potential injuries to caregivers and patients.

Survey your employees for advice

One effective way for leaders to gain valuable safety information is via confidential surveys with the employees.

Teresa Boynton, MS, OTR, CSPHP, of Mobility Consulting and Presentations, suggests developing surveys that ask open-ended questions, such as What tasks are you concerned about performing?; Are there any tasks that you find physically difficult?

Questions can be based on the setting. For instance, if you’re at an ASC, do the employees have concerns about being able to transfer patients on and off the procedure table? Or, if the patient is having an MRI or a CAT scan, does the employee have concerns about being able to properly transfer the patients? Answers to some of these questions can encourage facility leaders to look at patient handling, mobility and equipment issues, says Ms. Boynton.

“If patients had to be transferred from a stretcher or directly off the table to a wheelchair, check whether there’s a lift and a sling where we can do that safely without expecting staff to do that,” says Ms. Boynton.

For example, when caregivers are transferring a patient without the use of mobility equipment, usually four or more employees grab the sheets the patient is lying on to make a transfer from bed to table. But in cases of heavier patients, sheets have been known to tear and the risk of dropping the patient increases.

“The reality is that when you look at the injury data, typically two people are doing the majority of the work,” says Ms. Boynton. “They’re either positioned poorly; they’re positioned with the heaviest weight; or they have to twist their bodies to get the patient to where you want them to go,” says Ms. Boynton.

Some ASCs are addressing the awareness issues during admission and scheduling. That’s where specific questions can be asked so that everyone is aware if mobile or overhead equipment will be needed to transfer a patient of if lower-tech devices — such as straps and roller boards — can be used for safer lateral transfers.

Workstation evaluations, slip-and-trip prevention

Workstation injuries may happen often, but they’re typically not severe, according to Ms. Boynton, but that doesn’t mean you should ignore them.

“I see a lot of places that will get ergonomic chairs but they haven’t really looked at how the chair and the person interfaces with the keyboard, the mouse and the screen,” says Ms. Boynton. “I’ve been to a lot of places where you’re sitting on an expensive ergonomic chair that’s been adjusted for you but you can’t use it because they keyboard is situated too high or not angled properly, or the monitor may not be at the right height.”

Part of the problem, says Ms. Boynton, is that sometimes there isn’t proper training. “Look at some of the research that’s been done on what happens to the spine if you’re overloading it over time,” she says. “How do you instruct someone to keep the load close to them if it’s not possible to do it?”

Slips and trips are another major concern in the OR, but there are plenty of ways to reduce the risk. Cord covers and orange cord alerts are bright and easy to see, and a variety of specifically designed products go a long way toward keeping staff safe regardless of what’s around them.

Checking the checklist

According to recent AORN guidance, compliance and engagement are two challenges OR teams face when developing a surgical safety checklist.

Elizabeth Kingsbury, MSN, RN, CNOR, a champion of the surgical checklist, recommends adopting the following approaches:

• Create an interactive checklist and put it in question format. The RN can start by asking the surgeon, “What is the planned procedure?” and end by asking, “Does anyone have any additional safety concerns for this patient?” These questions give everyone in the room a chance to be included and engaged.

• Require a hard stop for the timeout. Empower the RN to ask the team to stop talking or moving during the timeout.

• Distribute handheld checklists. The circulator can have the checklist and consent forms in hand and stand close to the team while reading the checklist. This ensures not having to rely on one’s memory or remembering checklist questions.

• Make time for team introductions. Staffs can be large and have many different team members. The only time introductions should be waived is if there is a subsequent surgery with all the same team members.

• Sign in before induction. Consider starting the sign-in as soon as the patient enters the room and before the anesthesiologist starts administering medications to the patient. That’s the best time to grab everyone’s full attention.

Finally, don’t forget to audit your checklist compliance on a year round basis.

Reducing sharps accidents

CLUTTER KILLER Keeping your cords organized and away from high-traffic areas is a proven way to reduce slips and trips in the OR.

Sharps injuries are always a concern with surgery. To reduce sharps accidents and injuries in your OR, Ms. Boynton recommends the following steps:

• Track and trend needlestick and sharps incidents. Determine whether the accidents are associated with specific surgeons and/or types of surgeries by answering the following questions: Do some surgeons have a greater history of needlestick and sharps injuries? Are sharps incidents associated more with certain types of surgeries and specific devices? How frequently are incidents associated with passing instruments?

• Double-glove. If double-gloving is used, are near-misses reported and how often are outer gloves nicked? What is the acceptance of double-gloving? Would other approaches to preventing injuries be more accepted?

• Consider staff compliance with using safety-engineered devices. Fully investigate those that are not liked, and how/why they may be contributing to injuries or near-misses. Conduct ongoing evaluations of devices and document/record user feedback, including feedback from all potentially exposed workers.

• Establish a sharps-injury log that is communicated and shared in a meaningful way with frontline staff and surgeons. Share this info during daily staff meetings, at least weekly and/or on a communication board that is updated regularly. Summarize and share this information with all surgical personnel and use this information for continual improvement. Have the CMO, OR director and head surgical RN clearly establish and communicate expectations for all surgical personnel when it comes to reducing needlesticks and sharps injuries in the OR.

• Use OR-specific confidential comfort surveys and questionnaires to obtain a comprehensive picture. Collecting confidential feedback from staff can be beneficial when it comes to fully understanding the underlying causes of these types of injuries. Ask staff for their recommendations to address these types of injuries; encourage them to share their name if they want follow-up with them to get more detail.  Be mindful that if you are asking staff for their feedback, management needs to follow up with action plans, including short-term solutions and those that may require one-, two- or five-year planning. This may include having tough discussions with surgeons.

Don’t forget to actively reach out to and include surgeons in discussions. Ensure they understand the impact sharps and other injuries have on frontline staff, and potential consequences for failing to consistently follow safe, standardized practices implemented to ensure the safety of everyone in the OR.

• Take a closer look at training. If you provide annual training, evaluate the effectiveness of this annual training on sharps safety and the appropriate use and disposal of sharps devices for all potentially exposed workers.

Is there a more timely and effective way to address questions, concerns and issues to better ensure acceptance and compliance?

Review, review, review

Reviewing your safety procedures should be an ongoing practice. At the very least, safety procedures should be reviewed every quarter. When you have staff turnover, make sure the correct safety procedures are taught and emphasized to new employees, and always urge awareness of safety issues that could cause problems. Ask yourself, “Are we losing staff because they physically can’t do the tasks safely?”

“I know that once you get the right solutions in, then the staff can say, ‘This is working well for us’ when you check back in with them,” says Ms. Boynton. “If you’ve got a good solution but you don’t have the infrastructure to support it, it’s not going to work in the long run.”

And in the long-run, the safest possible environment must be top priority for your staff and your patients, alike. OSM